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目的:探讨小剂量多巴酚丁胺负荷超声(LDDSE)结合心肌背向散射积分(IBS)与负荷多普勒组织成像(DTI)检测存活心肌的准确性。方法:20例经冠状动脉定量造影术(QCA)确诊为冠心病患者行经皮冠状动脉介入治疗术(PCI)。术前1周内行LDDSE检查及采集IBS、DTI图像,术后(3月)复查二维超声。探索在LDDSE过程中,以IBS参数背向散射积分变异幅度(CVIB)最大变化率(K)>13定义为存活心肌,检测其识别存活心肌的准确性。以负荷下DTI最大Vs与静息时Vs的差值(T)>2.0cm/s定为存活心肌,检测其识别存活心肌的准确性。结果:LDDSE结合DTI或IBS技术检测存活心肌敏感性、特异性、准确性明显提高(P<0.05~0.01);LDDSE结合DTI较LDDSE结合IBS技术诊断存活心肌的敏感性、准确性降低(依次为78.9%,79.1%Vs 86.7%,87.1%)(P<0.05),尽管LDDSE结合DTI诊断存活心肌的特异性(81.25%)较LDDSE结合IBS(87.5%)降低,但差异无显著性意义。结论:LDDSE结合IBS较LDDSE结合DTI评估存活心肌灵敏性稍高。
Objective: To investigate the accuracy of LDDSE combined with myocardial backscatter integration (IBS) and Doppler tissue imaging (DTI) in detecting viable myocardium. Methods: Twenty patients undergoing coronary angiography underwent percutaneous coronary intervention (PCI) diagnosed by quantitative coronary angiography (QCA). One week before surgery, LDDSE examination and acquisition of IBS and DTI images were performed. Two-dimensional ultrasonography was reviewed postoperatively (March). Explore the LDDSE process, IBS parameter backscatter integral variation (CVIB) maximum rate of change (K)> 13 is defined as the survival of the myocardium to detect the accuracy of identifying viable myocardium. The difference between the maximum Vs of DTI and the resting Vs (T)> 2.0cm / s under load was defined as viable myocardium, and its accuracy in identifying viable myocardium was tested. Results: The sensitivity and specificity of LDDSE combined with DTI or IBS in detecting viable myocardium were significantly improved (P <0.05 ~ 0.01). LDDSE combined with LDDSE and IBS in diagnosis of viable myocardium showed a lower accuracy 78.9%, 79.1%, Vs 86.7%, 87.1%, respectively) (P <0.05). Although the specificity of LDDSE combined with DTI in diagnosis of viable myocardium (81.25%) was lower than that of LDDSE combined with IBS (87.5%), there was no significant difference. Conclusion: LDDSE combined with IBS is more sensitive to viable myocardium than LDDSE combined with DTI.